26 September 2008

That's what we joked, darkly, when I was in residency. The workload is so huge and the disruption so severe when someone was out, that there was tremendous pressure not to call in sick. In fact, I don't think I was ever directly discouraged from calling in sick, but there was just this understanding, that you had better really be sick if you missed a day.

I absorbed that ethic well, and in the twelve years of my career have taken fewer than twelve days off, I am sure. Most ER docs of my acquaintance share the same approach. I have been administering sick call for our group for a while, and I simply cannot recall anyone ever calling in for what seemed to be a frivolous reason.

But some are more Hard Core than others. I remember one morning, a few years back, when I came on shift. I was surprised to see that the partner who I was supposed to replace was on "the board" as a patient. This guy, I'll call him Bill, was famous in our group. He worked eighteen shifts a month and moonlighted as well. He always came in and got started thirty minutes early. He was an absolute shit magnet and always wound up with the knottiest, most difficult cases and always pulled it off with a smile. We joked that if we got sick, we would never let him care for us, not because he wasn't awesome, but because he would surely find some horrible diagnosis! (In fact, he was responsible for these two of my favoritecases.)

Apparently Bill had fallen ill while on shift. Fever, RLQ abdominal pain, a surgical consult and on the schedule for the OR for an appendectomy. He had a fairly large number of patients to sign out to me -- it had been a busy night. (We double cover at night, so the other doc helped as best he could till I got there.) I got the briefing and went to work, while Bill went upstairs to the OR.

The ER was swamped and I sort of forgot about Bill for a while. Eventually I got the labs and scans all back on one of my "inherited" patients, and I went to the room to let her know she was going to be admitted. Who should come out of the room, but Bill! He was wearing a hospital gown and robe, holding his IV pole, and laughing as he told the patient she was going to be admitted. He wisecracked, "Maybe we'll share a room!"

"What are you doing down here?" I asked, confused. He airily replied, "Oh, you know, I hadn't finished my dictations, and so I was looking in the computer and saw the results on this lady, so I thought I'd come down and dispo her for you, cause I know the story and the exam better. I'll just call the admitting doc and then I'll finish up my charts and go back upstairs."

At that moment, the surgeon rounded the corner. She stood all of five foot three, but her eyes were blazing with fury and she seemed to tower over us both. "What the hell do you think you are doing?!" She spat the words through gritted teeth, and I backed slowly away, lest she view me as an accomplice. "The nurses told me you had 'escaped' from post-op, and I didn't believe them, but this! This! I. Will. Not. Have. It." I think Bill tried, feebly, to explain himself, but she rode right over him in her rage. "You will stop what you are doing right now. You will lie down on this gurney," she gestured at an empty hallway bed, "and you will come back upstairs with me now. And if you so much as think of getting out of bed," she continued, "I will have you put in four-point restraints."

I endured a withering look from her as I helped Bill onto the gurney. He winced a bit, less from the pain than from the tongue-lashing that continued without pause as we got him situated. By this time a curious crowd of sober-looking nurses had gathered around, and watched impassively as the surgeon drafted a couple of idle hands to take her patient back upstairs. Only after they were safely out of sight did we, as one, erupt in hysterical laughter.

Wiping a tear from her eye, the charge nurse observed that only Bill would have pulled a stunt like that. She confessed that the post-op nurses had called down looking for Bill, and it was she that had ratted him out. I heard later that the surgeon had kept him in the hospital an extra day as punishment.

5 comments:

omg! My dad's an er doc and he did something similar to this a few years ago, or so the nurses told me. He rushed himself in after having an allergic reaction to something (in his tiny bermuda shorts, unfortunately, aahh). Anyway. I guess it was a busy night so once he's settled in...he offers to start signing orders/charts from his bed. lol I guess he was kind of dopey from the meds because the nurse telling the story was like "Yeah, everyone got a cardiac work-up that night."

The first part of the story, you could have been writing about my dad (who's name happens to be Bill). although he almost passed out in the on-call room & didn't tell anyone until after the nurses decided he simply looked too ill to continue, & admitted him. Turns out he had a bleeding ulcer - I guess he knew the ulcer was there, but didn't expect it to bleed...? Anyway, he was in the hospital for about three days, and I swear they ran every possible test on him (I heard of, at the least, an upper GI, a lower GI, and endoscopy, if those are all real tests), saying "who knows when he'll give us a chance to examine him again?"

This situation happened recently to one of our PAs. She developed the same symptoms: RLQ pain, nausea, fever.

We triaged her and put her in a bed, only to have her tell us to give it to someone else. She accepted antinausea meds, drank her gastrografin, and then saw patients. As she said, "What the hell else am I going to do for the next two hours while I wait for the CT scan?!?"

Had one of our PCP's once dx with an appy. early in the am. Scheduled himself for evening surgery, and went back to work for the day. He said, I work right across the street, If it gets worse, I'll come back. Only a doctor, I guess. I've definitely seen one of our ER docs walking around with an IV in for Toradol/Reglan when suffering a kidney stone.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

All Content is Copyright of the author, and reproduction is prohibited without permission.